The previous three sections described the state of the art in stem cell treatment in great detail, so much so it required 13,545 words. They say a picture is worth a thousand words. If so, we have another 36,000 words, plus videos, to offer the most illuminating insight into the brave new world of stem cells. Feel free to share this bleeding-edge medical excursion on social media, it’s definitely one of a kind.
This Regenexx Same-Day Stem Cell Procedure took place on Wednesday, April 13, followed by a lumbar PRP procedure on Thursday, April 21, 2022, in Las Vegas, Nev. Here’s how Regenexx describes the treatment (please note that the Prolotherapy was skipped):
- Bone Marrow Aspiration – The second day of the treatment is the stem cell injection. You will first be prepared for the bone marrow aspiration which entails taking bone marrow from the back of each of your hips (iliac crest). The bone marrow aspiration process is often described by patients as being only mildly uncomfortable and well-tolerated. You will lie on your stomach on the procedure table and an area at the back of your hip will be numbed. A special needle will be used to draw marrow blood out of this area. X-ray or ultrasound will be used to ensure the optimum location. This will be done on both sides of your hips.
- Stem Cell Injection – A few hours later you will receive your stem cell injections. The doctor will reinject your stem cells and natural growth factors from your blood platelets using advanced imaging guidance into the area in need of repair (real-time fluoroscopy or musculoskeletal ultrasound, using your MRI as a map for the injection). This allows the doctor to pinpoint the exact location of the injection, as well as the dispersion of the cells into the tissue.
- Super Concentrated Platelet (SCP) – The Regenexx Super Concentrated Platelet (SCP) and Platelet Lysate (PL) procedures use growth factors from your blood to promote damaged tissue repair. For most patients, the recommended SCP or PL protocol involves a blood draw and an injection on the same day.
The patient is a male diagnosed with left knee osteoarthritis (OA) and mild degenerative bulging of the L3-L4 and the L4-L5 discs in the lumbar spine. The technical details of the diagnosis are as follows:
- Meniscus – There is truncation of the inner free edge of the body, anterior, and posterior horn of the medial meniscus over a 3.5 cm segment with small severely macerated remnant portion of the meniscus, suggesting prior arthroscopic partial medial meniscectomy.
- MCL – There is mild edema along the MCL without rupture or laxity.
- Patella – There is mild edema along the lower pole the patella and proximal patellar tendon.
- Cartilage – Medial compartment articular cartilage shows severe full-thickness cartilage loss in the central weightbearing region, the medial tibial plateau and medial femoral condyle, with exposure of subchondral bone and moderate subchondral stress response. There are tricompartmental marginal osteophytes.
- L3-L4 – 2 to 3 mm asymmetric disc bulge, greatest in the foraminal regions, resulting in mild-moderate bilateral neural foraminal narrowing and mild central canal narrowing. There is no facet arthropathy.
- L4-L5 – 4 mm circumferential disc bulge resulting in mild central canal narrowing and mild bilateral neural foraminal narrowing.
In 1982, the blockbuster business book “In Search of Excellence: Lessons from America’s Best-Run Companies” listed this maxim as the epigraph of chapter five, “Eighty percent of success is showing up.” As with any medical procedure, the most important decision is to have one and show up.
09:41 am: The stem cell procedure will be performed at the Regenexx Las Vegas clinic of Dr. Joshua Goodwin.
09:49 am: Checking in with Patient Coordinator Jenn Palpallatoc at the front desk.
Regenexx is one of 60 clinics worldwide specializing in stem cell and PRP therapy. Regenexx Las Vegas has been in operation since 2016.
Blood Marrow Aspiration
After check-in, I was met by the friendly and proficient Radiologic Technologist Nina Runyan. She asked me a few questions and then pricked my hand for a small blood sample.
10:13 am: The patient is being prepped in OR. Notice the GE OEC 9800 Plus fluoroscopic x-ray machine with C arm.
The control panel of the GE OEC 9800 Plus allows the staff to change such parameters as collimation and contrast.
Bone marrow aspirate (BMA) is harvested from the posterior superior iliac crest region. Regenexx relies on both fluoroscopy x-ray and ultrasound. The SonoSite ultrasound image is on the left and the GE fluoroscopy image is right.
10:16 am: Needle entry areas are marked on the lower back. Goodwin typically aspirates bone marrow from three sites on each side of the iliac crest, the largest of three bones that make up the pelvis. One skin puncture offers access to three sites on either side of the bone.
10:17 am: Bone marrow extraction needles are ready to be used. Dr. Goodwin uses 18-gauge needles to aspirate bone marrow from the iliac crest, using advanced imaging guidance.
Gebauer Spray & Stretch, an instant topical anesthetic and skin refrigerant is applied to numb the skin and make it feel cool. The injection area is then prepped with EcoVue, a water-soluble, ultrasound gel that wipes off easily and acts as a conductor between skin and ultrasound transducer.
On the left is Naropin (ropivacaine), a local anesthetic, The Heparin bottles on the right are used to prevent the aspirate from coagulating. Prior to aspiration, 1 ml of heparin is added to each syringe to avoid clot formation.
10:19 am: A closeup of the injection area and needle shows the EcoVue gel and ultrasound probe used to provide imaging guidance. Read more about ultrasound devices in Why Have a Stem Cell Treatment?
10:36 am: Using the SonoSite ultrasound image, Dr. Goodwin is able to monitor the bone marrow aspiration process in realtime. The needle is clearly visible on the display, allowing for precise placement of the extraction needle.
Once the optimum illiac crest entry point has been located, Goodwin uses a battery-powered drill, an Arrow OnControl Powered Driver from Athlone, Ireland-based Teleflex, to drill the trochar and cannula (see definitions below) into the medullary cavity of the posterior iliac crest.
A tube that is inserted into the body to drain or inject fluid.
A pointed, hollow cylindrical device that is used to make small incisions and surgically insert cannulas into body cavities, or to aspirate fluids.
10:36 am: After the trochar is inserted into the iliac crest, a syringe pre-filled with 1 ml of heparin is attached to the trochar.
When bone marrow aspirate (BMA) is drawn from the iliac crest bone, the needle hits bone. That felt mildly uncomfortable but strangely enough, was less noticeable on the left side compared to the right. Even the drilling of bone was barely detectable.
10:51 am: A total of four 30-ml syringes, about 120 ml in total was harvested in this instance. Usually, approximately 60 ml of bone marrow is aspirated, which requires the use of two 30-ml syringes.
11:41 am: Nina Runyan performs a blood draw (called a phlebotomy) and extracts 12 vials of blood. After processing, these platelets are added to the BMAC injection performed that afternoon.
12:36 pm: After the bone marrow aspirate has been harvested, it’s processed in a centrifuge and turned into BMAC (bone marrow aspirate concentrate) in the lab and combined with the natural growth factors from drawn blood platelets.
Stem Cell Injection
The afternoon featured the main event: injecting BMAC plus a concentrated mix of the 12 vials of blood.
01:16 pm: The knee stem cell injection will take place under an intravenous injection of propofol — an anesthetic and sedative.
01:18 pm: Dr. Goodwin prepares the knee by cleaning it with a 60–70% alcohol-based solution (isopropyl alcohol or ethanol), followed by an application of Gebauer instant topical anesthetic.
01:19 pm: A knee closeup after EcoVue ultrasound gel was applied.
01:20 pm: There is enough Propofol here to knock out a horse. 😁
01:21 pm: Two syringes marked “bone” will be injected into the knee. The two syringes marked MCL are clearly the platelet-rich plasma (PRP) extracted earlier.
01:23 pm: The BMAC syringes are injected first in the knee.
01:31 pm: Followed by two PRP injections, the syringes marked MCL.
01:41 pm: Injecting the knee is challenging due to bone that interferes with ultrasound waves. That explains why fluoroscopy works better in the knee.
01:51 pm: By the end of the day that knee looks pretty bruised and swollen.
Today, April 21, 2022, is PRP (platelet-rich plasma) day, the final step in a Regenexx stem cell procedure that deals with two areas, kee and lumbar spine.
01:17 pm: The Feb. 3, 2022 spine MRI is displayed on the monitor.
01:21 pm: Nina Runyan points to the ultrasound display while Dr. Goodwin injects the knee with another syring labeled “Knee” SCP, as Regenexx calls PRP. That was preceded by an injection of lidocaine to numb the area.
01:22 pm: The syringes and medical instruments are ready. Blood was collected around 10:30 that morning and processed. Two syringes are labeled “PLM,” one is labeled “Contrast,” one “Lido” (lidocaine), two “Font” (?), one is illegible and another “Prolo,” although no prolotherapy is scheduled.
01:30 pm: The monitor shows a fluoroscopy image of the lumbar spine and what appears to be the needle, although it seems too large.
The spine is being prepared with a shot of lidocaine.
01:54 pm: To give you an idea of how deep that needle will go in…
…see this photo with the needle deeply inserted.
01:56 pm: What do you think this attachment does? Slow the flow?
02:47 pm: Procedure is done and the patient is still alive and smiling, although his face shows face-cradle dimples, here with Nina Runyan. 😂
After this major undertaking, the big question is, “did it work?” Below, is a recap that will be updated at six weeks, three months, six months, nine months, and one year. So, come back periodically, because some stem cell providers say results may not become apparent for as many as nine months.
| Date || Condition - Knee || Condition - Lumbar |
| May 25, 2022 || Knee is sore from 1 mile walk || Back condition unchanged |
| July 13, 2022 |
| Oct. 13, 2022 |
| Jan. 13, 2023 |
| Apr. 13, 2023 |
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